Prevalence, country-specific prescribing patterns and determinants of benzodiazepine use in community-residing older adults in 7 European countries.
Benzodiazepines
Community-dwelling older adults
Europe
Geriatric dosing
Geriatric length of therapy
Journal
BMC geriatrics
ISSN: 1471-2318
Titre abrégé: BMC Geriatr
Pays: England
ID NLM: 100968548
Informations de publication
Date de publication:
07 Mar 2024
07 Mar 2024
Historique:
received:
02
04
2023
accepted:
24
01
2024
medline:
8
3
2024
pubmed:
8
3
2024
entrez:
8
3
2024
Statut:
epublish
Résumé
The use of benzodiazepines (BZDs) in older population is often accompanied by drug-related complications. Inappropriate BZD use significantly alters older adults' clinical and functional status. This study compares the prevalence, prescribing patterns and factors associated with BZD use in community-dwelling older patients in 7 European countries. International, cross-sectional study was conducted in community-dwelling older adults (65 +) in the Czech Republic, Serbia, Estonia, Bulgaria, Croatia, Turkey, and Spain between Feb2019 and Mar2020. Structured and standardized questionnaire based on interRAI assessment scales was applied. Logistic regression was used to evaluate factors associated with BZD use. Out of 2,865 older patients (mean age 73.2 years ± 6.8, 61.2% women) 14.9% were BZD users. The highest prevalence of BZD use was identified in Croatia (35.5%), Spain (33.5%) and Serbia (31.3%). The most frequently prescribed BZDs were diazepam (27.9% of 426 BZD users), alprazolam (23.7%), bromazepam (22.8%) and lorazepam (16.7%). Independent factors associated with BZD use were female gender (OR 1.58, 95%CI 1.19-2.10), hyperpolypharmacy (OR 1.97, 95%CI 1.22-3.16), anxiety (OR 4.26, 95%CI 2.86-6.38), sleeping problems (OR 4.47, 95%CI 3.38-5.92), depression (OR 1.95, 95%CI 1.29-2.95), repetitive anxious complaints (OR 1.77, 95%CI 1.29-2.42), problems with syncope (OR 1.78, 95%CI 1.03-3.06), and loss of appetite (OR 0.60, 95%CI 0.38-0.94). In comparison to Croatia, residing in other countries was associated with lower odds of BZD use (ORs varied from 0.49 (95%CI 0.32-0.75) in Spain to 0.01 (95%CI 0.00-0.03) in Turkey), excluding Serbia (OR 1.11, 95%CI 0.79-1.56). Despite well-known negative effects, BZDs are still frequently prescribed in older outpatient population in European countries. Principles of safer geriatric prescribing and effective deprescribing strategies should be individually applied in older BZD users.
Sections du résumé
BACKGROUND
BACKGROUND
The use of benzodiazepines (BZDs) in older population is often accompanied by drug-related complications. Inappropriate BZD use significantly alters older adults' clinical and functional status. This study compares the prevalence, prescribing patterns and factors associated with BZD use in community-dwelling older patients in 7 European countries.
METHODS
METHODS
International, cross-sectional study was conducted in community-dwelling older adults (65 +) in the Czech Republic, Serbia, Estonia, Bulgaria, Croatia, Turkey, and Spain between Feb2019 and Mar2020. Structured and standardized questionnaire based on interRAI assessment scales was applied. Logistic regression was used to evaluate factors associated with BZD use.
RESULTS
RESULTS
Out of 2,865 older patients (mean age 73.2 years ± 6.8, 61.2% women) 14.9% were BZD users. The highest prevalence of BZD use was identified in Croatia (35.5%), Spain (33.5%) and Serbia (31.3%). The most frequently prescribed BZDs were diazepam (27.9% of 426 BZD users), alprazolam (23.7%), bromazepam (22.8%) and lorazepam (16.7%). Independent factors associated with BZD use were female gender (OR 1.58, 95%CI 1.19-2.10), hyperpolypharmacy (OR 1.97, 95%CI 1.22-3.16), anxiety (OR 4.26, 95%CI 2.86-6.38), sleeping problems (OR 4.47, 95%CI 3.38-5.92), depression (OR 1.95, 95%CI 1.29-2.95), repetitive anxious complaints (OR 1.77, 95%CI 1.29-2.42), problems with syncope (OR 1.78, 95%CI 1.03-3.06), and loss of appetite (OR 0.60, 95%CI 0.38-0.94). In comparison to Croatia, residing in other countries was associated with lower odds of BZD use (ORs varied from 0.49 (95%CI 0.32-0.75) in Spain to 0.01 (95%CI 0.00-0.03) in Turkey), excluding Serbia (OR 1.11, 95%CI 0.79-1.56).
CONCLUSIONS
CONCLUSIONS
Despite well-known negative effects, BZDs are still frequently prescribed in older outpatient population in European countries. Principles of safer geriatric prescribing and effective deprescribing strategies should be individually applied in older BZD users.
Identifiants
pubmed: 38454372
doi: 10.1186/s12877-024-04742-7
pii: 10.1186/s12877-024-04742-7
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
240Subventions
Organisme : NETPHARM New Technologies for Translational Research in Pharmaceutical Sciences
ID : CZ.02.01.01/00/22_008/0004607
Informations de copyright
© 2024. The Author(s).
Références
McIntosh B, Clark M, Spry C. Benzodiazepines in older adults: A review of clinical effectiveness, cost-effectiveness, and guidelines. Ottawa: Canadian Agency for Drugs and Technologies in Health; 2011 (Rapid Response Report: Peer-Reviewed Summary with Critical Appraisal). https://www.ncbi.nlm.nih.gov/books/NBK174561/pdf/Bookshelf_NBK174561.pdf . Accessed 22 Dec 2022.
Danish Health and Medicines Authority. Effective effort against the excessive use of benzodiazepines in Denmark. http://www.dkma.dk/en/topics/statistics-prices-and-reimbursement/statistics-and-analyses/analyses/consumptionanalyses/effective-effort-against-the-excessive-u--in-denmark . Accessed 22 Dec 2022.
Medicines and Healthcare products Regulatory Agency (MHRA). Addiction to benzodiazepines and codeine: supporting safer use. July 2011. http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON123123 . Accessed 22 Dec 2022.
Haute Autorité de Santé. Modalités d’arrêt des benzodiazépines et médicaments apparentés chez le patient âgé. 2007. http://www.has-sante.fr/portail/jcms/c_601509/modalites-d-arret-des-benzodiazepines-et-medicaments-apparentes-chez-le-patient-age?xtmc=benzodiaz%E9pines&xtcr=4 . Accessed 22 Dec 2022.
Bachhuber MA, Hennessy S, Cunningham CO, et al. Increasing benzodiazepine prescriptions and overdose mortality in the United States, 1996–2013. Am J Public Health. 2016;106:686–8. https://doi.org/10.2105/AJPH.2016.303061 .
doi: 10.2105/AJPH.2016.303061
pmcid: 4816010
Organisation for Economic Co-operation and Development. OECD/EU database. https://stats.oecd.org/index.aspx?DataSetCode=HEALTH_STAT . Accessed: 11 Dec 2023.
Lyons JS, Larson DB, Hromco J. Clinical and economic evaluation of benzodiazepines: a value analysis. Pharmacoeconomics. 1992;2:397–407.
doi: 10.2165/00019053-199202050-00007
Simon GE, Ludman EJ. Outcome of new benzodiazepine prescriptions to older adults in primary care. Gen Hosp Psychiatry. 2006;28(5):374–8. https://doi.org/10.1016/j.genhosppsych.2006.05.008 .
doi: 10.1016/j.genhosppsych.2006.05.008
pmcid: 2262838
Maust DT, Kales HC, Wiechers IR, et al. No end in sight: benzodiazepine use in older adults in the United States. J Am Geriatr Soc. 2016;64(12):2546–53. https://doi.org/10.1111/jgs.14379 .
doi: 10.1111/jgs.14379
pmcid: 5173408
Rothberg MB, Herzig SJ, Pekow PS, Avrunin J, Lagu T, Lindenauer PK. Association between sedating medications and delirium in older inpatients. J Am Geriatr Soc. 2013;61(6):923–30. https://doi.org/10.1111/jgs.12253 .
doi: 10.1111/jgs.12253
Gallacher J, Elwood P, Pickering J, et al. Benzodiazepine use and risk of dementia: evidence from the Caerphilly prospective study (CaPS). J Epidemiol Commun Health. 2012;66(10):869–73. https://doi.org/10.1136/jech-2011-200314 .
doi: 10.1136/jech-2011-200314
Woolcott JC, Richardson KJ, Wiens MO, et al. Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med. 2009;169(21):1952–60. https://doi.org/10.1001/archinternmed.2009.357 .
doi: 10.1001/archinternmed.2009.357
Koechl B, Unger A, Fischer G. Age-related aspects of addiction. Gerontology. 2012;58(6):540–4. https://doi.org/10.1159/000339095 .
doi: 10.1159/000339095
Ashton H. The diagnosis and management of benzodiazepine dependence. Curr Opin Psychiatry. 2005;18(3):249–55.
doi: 10.1097/01.yco.0000165594.60434.84
Dionne PA, Vasiliadis EM, Latimer E, et al. Economic impact of inappropriate benzodiazepine prescribing and related drug interactions among elderly persons. Psychiatr Serv. 2013;64:331–8. https://doi.org/10.1176/appi.ps.201200089 .
doi: 10.1176/appi.ps.201200089
Burrows AB, Morris JN, Simon SE, et al. Development of a minimum data set-based depression rating scale for use in nursing homes. Age Ageing. 2000;29(2):165–72. https://doi.org/10.1093/ageing/29.2.165 .
doi: 10.1093/ageing/29.2.165
World Health Organisation Collaborating Centre for Drug Statistics Methodology. The Anatomical Therapeutic Chemical (ATC) classification system and the Defined Daily Dose (DDD). https://www.whocc.no/ Updated March 23, 2020.Accessed 22 Dec 2022.
Renom-Guiteras A, Meyer G, Thürmann PA. The EU(7)-PIMlist: a list of potentially inappropriate medications for older people consented by experts from seven European countries. Eur J Clin Pharmacol. 2015;71:861–75. https://doi.org/10.1007/s00228-015-1860-9 .
doi: 10.1007/s00228-015-1860-9
pmcid: 4464049
By the 2019 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2019;67(4):674–94. https://doi.org/10.1111/jgs.15767 .
doi: 10.1111/jgs.15767
O’Mahony D, O’Sullivan D, Byrne S, et al. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2015;44:213–8. https://doi.org/10.1093/ageing/afu145 .
doi: 10.1093/ageing/afu145
Delaš Aždajić M, Likić R, Aždajić S, et al. Outpatient benzodiazepine utilization in Croatia: drug use or misuse. Int J Clin Pharm. 2019;41:1526–35. https://doi.org/10.1007/s11096-019-00915-2 .
doi: 10.1007/s11096-019-00915-2
The Agency for Medicinal Products and Medical Devices (Croatia). Medicinal Product Utilisation in Croatia (report) 2021. https://www.halmed.hr/en/Promet-proizvodnja-i-inspekcija/Promet/Potrosnja-lijekova/Izvjesca-o-prometu-lijekova/ . Accessed 22 Dec 2022.
Bužančić I, Pejaković TI, Ortner HM. A need for benzodiazepine deprescribing in the COVID-19 pandemic: a cohort study. Pharmacy. 2022;10(5):120. https://doi.org/10.3390/pharmacy10050120 .
doi: 10.3390/pharmacy10050120
pmcid: 9611451
Jakovljević M, Lacković Z. Benzodiazepini u suvremenoj medicini. 1st ed. Zagreb: Medicinska naklada; 2001.
Divac N, Todorović Z, Stojanović R, et al. Utilization of psychiatric drugs in Serbia. Vojnosanit Pregl. 2009;66(3):233–7. https://doi.org/10.2298/vsp0903233d .
doi: 10.2298/vsp0903233d
Divac N, Gašić J, Djukić LJ, Vujnović M, Babić D, Bajčetić M, et al. Benzodiazepines utilization and self-medication as correlates of stress in the population of Serbia. Pharmacoepidemiol Drug Saf. 2004;13(5):315–22. https://doi.org/10.1002/pds.940 .
doi: 10.1002/pds.940
Marković SZ, Dimitrijević Jovanović NI, Sedić B, et al. Impact of differences in economic development and socioeconomic stability on benzodiazepine exposure between the three Balkans countries. Psychiatr Danub. 2019;31(Suppl 5):750–60.
Perković Vukčević N, Vuković Ercegović G, Šegrt Z, et al. Benzodiazepine poisoning in elderly. Vojnosanit Pregl. 2016;73(3):234–8. https://doi.org/10.2298/VSP141208025P .
doi: 10.2298/VSP141208025P
Spanish Agency for Medicines and Health Products. Circular 3/2000: Information that must appear in the data sheet of pharmaceutical specialties whose composition includes a benzodiazepine or analog (zolpidem, zopiclone), with the indication of anxiolytic and/or hypnotic. https://www.sefh.es/alertas/alertas8.htm . Accessed 11 Dec 2023.
ABIM Foundation. Choosing Wisely. http://www.choosingwisely.org/ . Accessed 11 Dec 2023.
Nicieza-García ML, Salgueiro-Vázquez ME, Jimeno-Demuth FJ, et al. Beers versus STOPP criteria in polyharmacy community-dwelling older patients. Farm Hosp. 2016;40(3):150–64. https://doi.org/10.7399/fh.2016.40.3.9706 .
doi: 10.7399/fh.2016.40.3.9706
Guisado-Clavero M, Violán C, López-Jimenez T, et al. Medication patterns in older adults with multimorbidity: a cluster analysis of primary care patients. BMC Fam Pract. 2019;20(1):82. https://doi.org/10.1186/s12875-019-0969-9 .
doi: 10.1186/s12875-019-0969-9
pmcid: 6567459
López-Pelayo H, Coma A, Gual A, et al. Call for action: benzodiazepine prescription prevalence analysis shows off-label prescription in one in eleven citizens. Eur Addict Res. 2019;25:320–9. https://doi.org/10.1159/000502518 .
doi: 10.1159/000502518
de las Cuevas C, Sanz E, de las Fuente J. Benzodiazepines: more “behavioural” addiction than dependence. Psychopharmacology. 2003;167:297–303. https://doi.org/10.1007/s00213-002-1376-8 .
doi: 10.1007/s00213-002-1376-8
Ministry of Health. Pharmaceutical Benefit in the National Health System, 2020–2021. Monographic report. Reports, Studies and Research. 2022. [In Spanish]. https://cpage.mpr.gob.es/producto/informe-monografico-prestacion-farmaceutica-en-el-sistema-nacional-de-salud/ . Accessed 22 Dec 2022.
Díaz-Gutiérrez MJ, Martínez-Cengotitabengoa M, Bermúdez-Ampudia C, et al. Overdosing of benzodiazepines/Z-drugs and falls in older adults: costs for the health system. Exp Gerontol. 2018;110:42–5. https://doi.org/10.1016/j.exger.2018.05.002 .
doi: 10.1016/j.exger.2018.05.002
Marquina-Márquez A, Olry-de Labry-Lima A, Bermúdez-Tamayo C, Ferrer López I, Marcos-Marcos I. Identifying barriers and enablers for benzodiazepine (de)prescription: a qualitative study with patients and healthcare professionals. An Sist Sanit Navar. 2022;45(2):e1005. https://doi.org/10.23938/ASSN.1005 .
doi: 10.23938/ASSN.1005
pmcid: 10130797
Kristen T, Milushewa P, Tachkov K. Impact of polypharmacy, drug-related problems, and potentially inappropriate medications in geriatric patients and its implications for Bulgaria - narrative review and meta-analysis. Front Public Health. 2022;10:743138. https://doi.org/10.3389/fpubh.2022.743138 .
doi: 10.3389/fpubh.2022.743138
Lukačišinová A, Fialová D, Peel NM, et al. The prevalence and prescribing patterns of benzodiazepines and Z-drugs in older nursing home residents in different European countries and Israel: retrospective results from the EU SHELTER study. BMC Geriatr. 2021;21:277. https://doi.org/10.1186/s12877-021-02213-x .
doi: 10.1186/s12877-021-02213-x
pmcid: 8077828
Akpinar A, Yaman AR, Karakus K, et al. The frequent of benzodiazepine use in the Isparta province. Klinik Psikofarmakol Bülteni. 2016;26(2):169–74. https://doi.org/10.5455/bcp.20150707103818 .
doi: 10.5455/bcp.20150707103818
Asicioglu F, Esra Kucukibrahimoglu E, Ilingi U. Psychotropic drugs evaluated in the context of narcotic drugs according to the new Turkish criminal law. Klinik Psikofarmakol Bülteni. 2010;20(4):314–20. https://doi.org/10.1080/10177833.2010.11790678 .
doi: 10.1080/10177833.2010.11790678
Egan MY, Wolfson C, Moride Y, et al. High daily doses of benzodiazepines among Quebec seniors: prevalence and correlates. BMC Geriatr. 2001;1:4. https://doi.org/10.1186/1471-2318-1-4 .
doi: 10.1186/1471-2318-1-4
pmcid: 61036
Cloos JM, Bocquet V, Rolland-Portal I, et al. Hypnotics and triazolobenzodiazepines – best predictors of high-dose benzodiazepine use: results from the Luxembourg National Health Insurance Registry. Psychother Psychosom. 2015;84:273–83. https://doi.org/10.1159/000434755 .
doi: 10.1159/000434755
Chena Y, Liuc C, Change C, et al. Perceptions, clinical characteristics, and other factors associated with prolonged and high daily dose of benzodiazepine use among patients with anxiety or depressive disorders. J Affect Disord. 2020;271:215–23. https://doi.org/10.1016/j.jad.2020.03.077 .
doi: 10.1016/j.jad.2020.03.077
Davies SJ, Rudoler D, de Oliveira C, et al. Comparative safety of chronic versus intermittent benzodiazepine prescribing in older adults: a population-based cohort study. J Psychopharmacol. 2022;36(4):460–9. https://doi.org/10.1177/02698811211069096 .
doi: 10.1177/02698811211069096
pmcid: 9066681
National Institute for Health and Care Excellence (NICE). Dementia: Assessment, Management and Support for People Living with Dementia and Their Carers NICE Guidance [NG97]. https://www.nice.org.uk/guidance/ng97 . Accessed 11 Dec 2023.
Reus VI, Fochtmann LJ, Eyler AE, et al. The American Psychiatric Association practice guideline on the use of antipsychotics to treat agitation or psychosis in patients with dementia. Am J Psychiatry. 2016;173:543–6.
doi: 10.1176/appi.ajp.2015.173501
Keltner NL, Folks DG. The omnibus budget reconciliation act: impact on psychotropic drug use in long-term care facilities. Perspect Psychiatr Care. 1995;31:30–3.
Tannenbaum C, Martin P, Tamblyn R, et al. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial. JAMA Intern Med. 2014;174:890–8.
doi: 10.1001/jamainternmed.2014.949
Breen J, Jackson S, Gee P, et al. An effective approach to decrease antipsychotic and benzodiazepine use in nursing homes: the RedUSe project. Int Psychogeriatr/IPA. 2009;22:26–36.
Brodaty H, Aerts L, Harrison F, et al. Antipsychotic deprescription for older adults in long-term care: the HALT study. J Am Med Dir Assoc. 2018;19:592-600.e7.
doi: 10.1016/j.jamda.2018.05.002
Bednarczyk E, Cook S, Brauer R, Garfield S. Stakeholders‘ views on the use of psychotropic medication in older people: a systematic review. Age Ageing. 2022;51:1–11. https://doi.org/10.1093/ageing/afac060 .
doi: 10.1093/ageing/afac060
Jyrkka J, Englund H, Korhonen MJ, Sulkava R, Hartikainen S. Patterns of drug use and factors associated with polypharmacy and excesive polypharmacy in elderly persons. Drugs Aging. 2009;26(12):1039–48. https://doi.org/10.2165/11319530-000000000-00000 .
doi: 10.2165/11319530-000000000-00000
Nothelle SK, Sharma R, Oakes A, Jackson M, Segal JB. Factors associated with potentially inappropriate medication use in community-dwelling older adults in the United States: a systematic review. Int J Pharm Pract. 2019;27(5):408–23. https://doi.org/10.1111/ijpp.12541 .
doi: 10.1111/ijpp.12541
pmcid: 7938818
Dealberto MJ, Seeman T, McAvay GJ, et al. Factors related to current and subsequent psychotropic drug use in an elderly cohort. J Clin Epidemiol. 1997;50(3):357–64. https://doi.org/10.1016/s0895-4356(96)00339-3 .
doi: 10.1016/s0895-4356(96)00339-3
Newman SC, Hassan AI. Antidepressant use in the elderly population in Canada: results from a national survey. J Gerontol A Biol Sci Med Sci. 1999;54:M527-530. https://doi.org/10.1093/gerona/54.10.m527 .
doi: 10.1093/gerona/54.10.m527
Olfson M, King M, Schoenbaum M. Benzodiazepine use in the United States. JAMA Psychiat. 2015;72(2):136–42. https://doi.org/10.1001/jamapsychiatry.2014.1763 .
doi: 10.1001/jamapsychiatry.2014.1763
Anderson K, Stowasser D, Freeman C, et al. Prescriber barriers and enablers to minimising potentially inappropriate medications in adults: a systematic review and thematic synthesis. BMJ Open. 2014;4(12):e006544. https://doi.org/10.1136/bmjopen-2014-006544 .
doi: 10.1136/bmjopen-2014-006544
pmcid: 4265124
Rivasi G, Kenny RA, Ungar A, et al. Effects of benzodiazepines on orthostatic blood pressure in older people. Eur J Intern Med. 2020;72:73–8. https://doi.org/10.1016/j.ejim.2019.10.032 .
doi: 10.1016/j.ejim.2019.10.032
Brignole M, Rivasi G. New insights in diagnostics and therapies in syncope: a novel approach to non-cardiac syncope. Heart. 2020;107(11):864–73. https://doi.org/10.1136/heartjnl-2020-318261 .
doi: 10.1136/heartjnl-2020-318261
Gill TM, Murphy TE, Gahbauer EA, et al. Association of injurious falls with disability outcomes and nursing home admissions in community-living older persons. Am J Epidemiol. 2013;178(3):418–25. https://doi.org/10.1093/aje/kws554 .
doi: 10.1093/aje/kws554
pmcid: 3816345
Seppala LJ, Wermelink AMAT, de Vries M, et al. Fall-risk-increasing drugs: a systematic review and meta-analysis: II. Psychotropics J Am Med Dir Assoc. 2018;19(4):371.e11-371.e17. https://doi.org/10.1016/j.jamda.2017.12.098 .
doi: 10.1016/j.jamda.2017.12.098
Xing D, Ma XL, Ma JX, et al. Association between use of benzodiazepines and risk of fractures: a meta-analysis. Osteoporos Int. 2014;25(1):105–20. https://doi.org/10.1007/s00198-013-2446-y .
doi: 10.1007/s00198-013-2446-y
Cooper SJ. Benzodiazepines and appetite: recent pre-clinical advances and their clinical implications. Hum Psychopharmacol: Clin & Experiment. 1989;4(2):81–9. https://doi.org/10.1002/hup.470040203 .
doi: 10.1002/hup.470040203
Ashton H. Benzodiazepines: How they work & how to withdraw. Revised August 2022. Newcastle University. https://benzo.org.uk/manual/ . Accessed 22 Dec 2022.